How to know if you’re headed for burnout and 3 things you can do to turn the tide

January 15, 2018

It might sound strange that you could be hurtling toward burnout and not know it, but it happens all the time.

Burnout is a bit of a tricky phenomenon. You might be so conditioned to stress that you don’t realize you’re at your limit until you’re already over the edge, ready to give up on your career or run away from home (I’m only partly kidding here).

This is because a lot of us are really good at ignoring early signs of overwork and chronic stress. We set aside our own needs as unnecessary or unrealistic, or incorrectly attribute how we’re feeling to some other issue (“I’m sick again…must be the kids bringing home a ton of germs,” or “I can’t stand that patient — so entitled and demanding.”) You may actually be getting sick a lot because you are carrying around an unhealthy amount of emotional stress and your immune system is compromised. You may be ready to fire your patient because your fuse is short and your empathy supply is running dangerously low, both warning signs of burnout.

Burnout is characterized by three main criteria (thanks to UR’s Dr. Michael Privitera for breaking it down so well in his July 2017 article “Physician Burnout as an Individual and Public Health Issue”).

The examples are written in terms of what physicians or other health care professionals might encounter, but the basic criteria are the same regardless of your profession — and can even show up in the context of home if family life is what’s burning you out:

Emotional exhaustion: procrastination of important patient/client interactions (i.e. returning phone calls), self-isolation, irritability, low mood, “short fuse.” The people in your life, including patients, family members and/or friends, are beginning to notice a change in you and might even comment on it.

Depersonalization/callousness: distancing from patients during appointments, decreased listening & compassion, more cynicism and sarcasm when discussing patients/clients (i.e. when staffing a case or consulting with another provider)

Decreased efficacy: low confidence, worries about ability to perform work tasks, perceived poor decision-making (which in time will become *actual* poor decision-making), decreased ability to engage in the thinking and problem-solving necessary to the job — e.g. sorting through the facts of a case, making accurate diagnoses, considering all possible differential diagnoses, and making a sound care plan.

It snowballs. At first you’re tired, physically unwell, increasingly unpleasant to be around. You start to lose perspective and so-called difficult patients become harder and harder to tolerate — you just don’t have the bandwidth. You start to question your abilities and as symptoms get worse, your cognitive functioning deteriorates. You’re so overloaded, your brain lapses into “habit memory,” and does a less effective job at synthesizing facts and information. You’re more prone to mistakes, sometimes very costly ones.

Burnout is treatable. Here are three things you can do today to start shifting out of burnout and into a more energetic and empowered space:

Recognize what is within your sphere of control. When we are feeling lousy, it’s easy to focus on all the stuff that we can’t change (e.g. the intense demands imposed by the EMR) while ignoring very real, very powerful things that ARE within our control (e.g. how much energy you put into your notes; putting the phone away when you get home on nights you’re not on call; your mindset — what you think and how you feel about yourself).

Make one small change to your routine. Choose one thing that’s under your power and consider shifting it. Is your Netflix habit keeping you up too late? Is the midday vending machine trip causing you to crash 30 minutes later? It may sound overly simplistic, but if you can identify one thing that’s interfering with your sleep or diet and cut it out or modify it, you may unlock some additional mental clarity and energy. Do not underestimate the power of one small change. You need to start thinking about easy ways to conserve or bolster your energy.

Stop seeing self-care as an unrealistic or pointless exercise in self-indulgence. Ideally, self-care should be integrated into your life in a seamless way, without a side of guilt. Many other cultures do this SO MUCH BETTER THAN WE DO. And there’s a lot about the subculture of medicine that perpetuates unrealistic expectations and the value of “gutting it out.” Get creative here! I can’t tell you how often I hear people say that they can’t make time for therapy or a therapy group (which I see as one of the highest forms of self-care) but when something is important enough to you there is ALWAYS a way. True self-care may not be super comfortable or blissful in the moment…exercise, therapy, writing/journaling time, a few hours carved out to make art or music…these activities require you to push past the initial resistance, but it’s in service of a larger goal of a fulfilling, productive life.

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As always, please reach out if you would like to come in for a session and strategize what burnout prevention would look like for you. And if you might be interested in joining a transformative therapy group in 2018, complete an interest form here 🙂 HINT: group is always transformative!